Décès et dispositifs transdermiques au fentanyl : 9 cas et revue de la littérature

This paper presents a series of 9 fatalities occurred in the context of use or misuse of fentanyl transdermal (TD) patches (Durogesic® or generic). Case reports include 5 men and 4 women aged 26 to 73 years, with a number of patches by individual from 1 to 16 (doses of 48 to 1500 μg/h). Eight cases corresponded to multiple-patch cutaneous applications (in one case together with a possible, concomitant intravenous injection of fentanyl recovered by deconditioning of one or more patches), and one case was by ingestion of a patch. The postmortem fentanyl blood concentrations were found to range from 2.2 to 234 ng/mL. In view of the data in the literature, the authors highlight the difficulties of interpretation raised by these forensic situations, particularly with regard to the responsibility of the fentanyl TD device(s) in the occurrence of death; several factors (proximity or even overlap between therapeutic and toxic blood levels, frequency of mixed-drug intoxications, postmortem redistribution) make it problematic to conclude on the sole basis of blood levels, and require to take into account all available data (case history, autopsy, histology).